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1.
Isr Med Assoc J ; 22(1): 13-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927799

RESUMO

BACKGROUND: During Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) the surgeon operates exclusively through a single vaginal entry point, leaving no external scarring. OBJECTIVES: To evaluate the learning curve of vNOTES hysterectomy by experienced gynecologists based on surgical times and short-term outcomes. METHODS: A retrospective study was conducted of the first 25 vNOTES hysterectomy surgeries performed from July to December 2018 at Rambam Health Care Campus by a single surgeon. The primary outcome was hysterectomy time. Secondary outcomes included intra-operative bleeding, length of hospitalization, postoperative pain, and need for analgesia. Socio-demographic and clinical data were retrieved from patient electronic medical charts. RESULTS: Median age was 64.5 years (range 40-79). Median hysterectomy time was 38 minutes (range 30-49) from the first cut until completion. Comparisons between median hysterectomy time in the first 10 hysterectomies and in the 15 subsequent procedures demonstrated a significant decrease in median total time: 45 minutes (range 41-49) vs. 32 minutes (range 30-38), respectively (P = 0.024). The median estimated intraoperative blood loss decreased from 100 ml (range 70-200) in the first 10 hysterectomies to 40 ml (range 20-100) in the subsequent procedures (P = 0.011). CONCLUSIONS: vNOTES hysterectomy is feasible by an experienced gynecologist, with an exponential improvement in surgical performance in a short period as expressed by the improvement in hysterectomy time, low complication rates, negligible blood loss, minimal post-surgical pain, fast recovery, and short hospitalization. vNOTES allows easier and safer access to adnexal removal compared to conventional vaginal surgery.


Assuntos
Ginecologia/educação , Histerectomia Vaginal/educação , Curva de Aprendizado , Cirurgia Endoscópica por Orifício Natural/educação , Adulto , Idoso , Feminino , Humanos , Histerectomia Vaginal/métodos , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
5.
BMC Surg ; 19(1): 146, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619236

RESUMO

BACKGROUND: Simulation in laparoscopic surgery is nowadays recognized as a valid instrument for learning and training surgeons in different procedures. However, its role as evaluation test and self-assessment tool to verify basic surgical skills is still under discussion. METHODS: Thirty-three residents in obstetrics and gynecology at University of Pisa, Italy were recruited, and they received a simulation program consisting of 5 tasks. They had to perform basic laparoscopic surgery maneuvers as creating pneumoperitoneum, positioning trocars under vision, demonstrating the appropriate use of dominant and non-dominant hand and making single stitch and knot. They were evaluated with a modified OSATs scale. RESULTS: Senior trainees had better score than junior trainees (p value< 0,005) and after different sessions of simulation scores of both groups significantly improved (p < 0,001), especially for the junior group. All the trainees reported self-assessments that matched with the evaluation of external observers demonstrating the importance of simulation also as auto-evaluation test. CONCLUSIONS: In this study, we demonstrated the role of simulation as powerful tool to evaluate and to self-assess surgical technical skills and to improve own capacities, with the use of a modified OSATs scale adapted to specific exercises.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/educação , Internato e Residência , Laparoscopia/educação , Treinamento por Simulação , Competência Clínica , Ginecologia/educação , Humanos , Itália , Cirurgiões/educação
6.
J Pediatr Adolesc Gynecol ; 32(5S): S7-S13, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31585618

RESUMO

Professional organizations agree that adolescents are good candidates for intrauterine device (IUD) use. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists affirm that IUDs should be considered first-line as contraceptive methods for adolescents. Although the number of teens using IUDs is growing, multiple barriers remain, including systems, and patient- and provider-level obstacles. Only through concerted efforts and a committed action plan will adolescents achieve better access to IUDs.


Assuntos
Acesso aos Serviços de Saúde , Dispositivos Intrauterinos/estatística & dados numéricos , Contracepção Reversível de Longo Prazo/métodos , Adolescente , Feminino , Ginecologia/educação , Ginecologia/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Guias de Prática Clínica como Assunto , Gravidez , Gravidez na Adolescência/prevenção & controle
7.
Gynecol Oncol ; 155(2): 359-364, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31575391

RESUMO

OBJECTIVE: To assess whether there were any significant changes in surgical training volume over the past 20 years that might have ramifications toward preparedness for practice. METHODS: We used deidentified annual summaries of fellow case numbers for the academic years 1999 through 2018. Unpaired t-tests with Welch's correction were performed on all surgical categories for 10-year and 5-year periods. RESULTS: The total number of hysterectomies performed each year did not change significantly. The percent of hysterectomies performed by minimally invasive surgery increased significantly starting in 2008. There was a significant decline in the number of radical hysterectomies conducted starting after 2004, which then remained stable. There was also a significant decline in the number of bowel resections/anastomoses performed by fellows on the gynecologic oncology services that occurred and stabilized during the same time frame. There were other significant trends associated with the introduction of minimally invasive techniques. CONCLUSION: The results of this study suggest the need to reevaluate fellowship training and/or the scope of surgical practice in gynecologic oncology.


Assuntos
Educação de Pós-Graduação em Medicina/tendências , Bolsas de Estudo/tendências , Procedimentos Cirúrgicos em Ginecologia/educação , Ginecologia/educação , Oncologia/educação , Bolsas de Estudo/estatística & dados numéricos , Feminino , Florida , Procedimentos Cirúrgicos em Ginecologia/tendências , Ginecologia/tendências , Humanos , Histerectomia/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Excisão de Linfonodo/estatística & dados numéricos , Oncologia/tendências , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos
8.
Rev. méd. Urug ; 35(3): 218-223, set. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1023707

RESUMO

La Clínica Ginecotocológica A (CGA) de la Facultad de Medicina (FM) se ha comprometido con los objetivos de la reforma sanitaria en lo referente a la formación de posgrados, trabajando para ello en la descentralización de los escenarios de enseñanza-aprendizaje. En esta publicación se presenta la estrategia de descentralización de la formación de posgrados de ginecotocología de la CGA en el período 2010-2018. Se describen las herramientas que permiten mantener el contacto de los posgrados y tutores sustentados en tecnologías de la comunicación para realizar regularmente ateneos, actividades tutoriales, teleclínicas. Por otro lado, se describe la distribución logrado de postgrados, así como el logro de las destrezas en los diferentes Centros Docentes Asociados (CEDA). De la evaluación del funcionamiento de la red de CEDA de la CGA, así como de los logros formativos de recursos humanos, se concluye que es factible el aumento del cupo formativo de posgrados de Ginecotocología apelando a la descentralización estructurada de los escenarios de aprendizaje.


The Gynecotocology Clinic A (GCA) of the School of the School of Medicine is committed to the goals set in the health reform in terms of the training of postgraduates, and thus has focused on the decentralization of the educational scenario. This study presents the decentralization strategy in the training of postgraduate students in gynecotocology of the GCA between 2010 and 2018. It describes the tools that allow keeping in touch with the posgraduate students and tutors by means of technology that regularly aids grand rounds, tutorial activities, remote clinics, etc. Also, a description of the distribution of achievements by psotgraduates is provided, as well as the achievement of skills in the different Associated Teaching Centers (CEDAs in Spanish). Upon the assessment of performance of the CEDAs network of CGA, as well as the educational achievements in human resources, a conclusion is drawn as to the feasibility of increasing the number of postgraduates trained in gynecotocology appealing to structured decentralization strategies for the learning scenario.


A Clínica Ginecotocológica A (CGA) da Faculdade de Medicina (FMed-UDELAR) está comprometida com os objetivos da reforma sanitária no que diz respeito à formação dos pós-graduandos, trabalhando para isso na descentralização dos cenários de ensino-aprendizagem. Nesta publicação apresenta-se a estratégia de descentralização da formação dos pós-graduandos de ginecologia e obstetrícia da CGA no período 2010-2018. Descreve-se as ferramentas que permitem manter o contacto entre pós-graduandos e supervisores utilizando tecnologias da comunicação para realizar regularmente discussão de casos clínicos, atividades de supervisão e tele clínicas. Por outro lado, apresenta-se a distribuição geográfica dos pós-graduandos, bem como os resultados da obtenção de destrezas nos diferentes Centros docentes Associados (CEDA). A avaliação do funcionamento da rede de CEDA da CGA e dos resultados da formação de recursos humanos, permite concluir que é factível aumentar as vagas para pós-graduandos de ginecologia e obstetrícia utilizando a descentralização estruturada dos cenários de aprendizagem.


Assuntos
Educação de Pós-Graduação , Ginecologia/educação , Educação Médica Continuada
9.
J Grad Med Educ ; 11(4 Suppl): 100-103, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31428265

RESUMO

Background: The quality of the learning environment in the operating room (OR) is vital for the training of surgical residents. Tools with validity evidence exist to measure resident perceptions of the operative learning environment, yet to date no studies have assessed this environment for obstetrics and gynecology residency programs in the United Arab Emirates (UAE). Objective: We explored perceptions of obstetrics and gynecology residents regarding their operative learning environment in 2 hospitals in Abu Dhabi, UAE. Methods: Our cross-sectional study was conducted in 2018 using the validated Surgical Theater Educational Environmental Measure (STEEM) questionnaire for trainee assessments in the OR learning environment. The 4 STEEM subscales measure teaching and training, learning opportunities, overall atmosphere, and supervision, workload, and support, respectively. Cronbach's alpha and intraclass correlation were used to establish the internal consistence and reliability of the questionnaire. We calculated an overall score and compared scores between the 2 institutions using Student's t test. Results: Thirty-one residents completed the questionnaire (18 at Corniche Hospital and 13 at Al Ain Hospital). The overall average STEEM score was 142.1. The score for residents at Corniche Hospital was 134.9 and that for Al Ain Hospital was 152.2, with better overall scores on 3 STEEM domains at Al Ain Hospital. Conclusions: Our study showed that obstetrics and gynecology residents in the UAE have a positive perception of their operative learning environment. We also identified areas for improvement.


Assuntos
Ginecologia/educação , Internato e Residência/organização & administração , Aprendizagem , Obstetrícia/educação , Salas Cirúrgicas , Estudos Transversais , Humanos , Reprodutibilidade dos Testes , Procedimentos Cirúrgicos Operatórios , Inquéritos e Questionários , Emirados Árabes Unidos
11.
BMC Res Notes ; 12(1): 411, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307518

RESUMO

OBJECTIVE: From 2012 to 2015, two Departments of Obstetrics and Gynecology and two Departments of Pediatrics at the University of Copenhagen implemented an English medium international project. The project allowed international students to work in pairs with local Danish speaking students in a clinical setting. The student cohort was supported by Danish doctors who were responsible for student-pair supervision in English and, ultimately, patient care. Drawing on survey responses of 113 Danish doctors, this study considers the doctors' overall evaluation of the program and their perception of the international students' knowledge, skills and attitudes compared with local students. RESULTS: The Danish doctors rated the international and local students comparable in respect to professional commitment (p = 0.347), academic level (p = 0.134), and English proficiency (p = 0.080). The Danish doctors rated the international students significantly lower than the local students regarding communication with Danish doctors, other hospital staff, and patients (p < 0.001 in all cases). Ninety percent of the doctors involved in the project supported continuing working with internationalization if it included mixed pairs of students and a Danish doctor assigned each day to be exclusively responsible for student supervision. Language barriers for international medical students could be overcome but required substantial faculty support.


Assuntos
Educação Médica/normas , Hospitais Públicos , Hospitais Universitários , Médicos/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Adulto , Competência Clínica/normas , Comunicação , Dinamarca , Feminino , Ginecologia/educação , Humanos , Internacionalidade , Masculino , Obstetrícia/educação , Pediatria/educação , Inquéritos e Questionários
12.
JSLS ; 23(2)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31285653

RESUMO

Background and Objectives: Skills-lab training is crucial for the development of advanced laparoscopic skills. In this study, we examined whether a systematic deconstructive and comprehensive tutoring approach improves training results in laparoscopic suturing and intracorporeal knot tying. Methods: Sixteen residents in obstetrics and gynecology participating in structured skills-lab laparoscopy training were randomized in 2 equal-sized groups receiving 1-on-1 tutoring either in the traditional method or according to the Peyton's 4-step approach, involving an additional training step, with the trainees instructing the tutor to perform the exercises. A validated assessment tool (revised Objective Structured Assessment of Technical Skills) and the number of completed square knots per training session and the mean time per knot were used to assess the efficacy of training in both groups. Results: Trainees in Peyton's group achieved significantly higher revised Objective Structured Assessment of Technical Skills scores (28.6 vs 23.9 points; P = .05) and were able to improve their scores during autonomous training repetitions, in contrast to the trainees not in Peyton's group (difference +4.75 vs -4.29 points, P = .02). Additionally, they seemed to be able to perform a greater number of successful knots during the exercise and to complete each knot quicker with the later observations failing to reach the threshold of statistical significance. Conclusion: Peyton's 4-step approach seemed to be superior for teaching laparoscopic skills to obstetrics and gynecology residents in the skills-lab setting and can be therefore proposed for training curricula.


Assuntos
Currículo , Ginecologia/educação , Internato e Residência , Laparoscopia/educação , Obstetrícia/educação , Técnicas de Sutura/educação , Adulto , Competência Clínica , Feminino , Humanos , Masculino
13.
JSLS ; 23(2)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31148914

RESUMO

Background and Objectives: Physicians typically have little information of surgical device pricing, although this trend has not been studied in the field of obstetrics and gynecology. We therefore aimed to determine how accurately obstetrician-gynecologists estimate surgical device prices, and to identify factors associated with accuracy. Methods: An anonymous survey was emailed to all obstetrician-gynecologist attendings, fellows, and residents at 3 teaching hospitals in a single healthcare system in Arizona. We obtained demographic data, perceptions of price transparency and self-rated price knowledge, and price estimates for 31 surgical devices. Results: After participants provided consent and demographics, they then estimated the purchasing price of 31 devices. We defined price accuracy as being within ±10% of the hospital's purchasing price. Fifty-six of the 170 (32.9%) invitees completed the survey and 48 (28.2%) provided price estimates. On average, participants identified 1.9 items correctly (6.1%; range, 0-7 items) out of 31 with no difference in accuracy based on seniority, surgical volume, physician reimbursement structure, nor subspecialty practice-focus. All (100%) respondents felt pricing should be transparent, and only 1.8% felt it is at least somewhat transparent. Conclusion: We found that price-estimate accuracy was very low and had no association with any of the demographics. Also notable was the perception that pricing is not transparent despite a unanimous desire for transparency. Although physicians reported a preference for using less-expensive surgical devices, we conclude that physicians are unequipped to make cost-conscious decisions highlighting a large potential for education.


Assuntos
Atitude do Pessoal de Saúde , Ginecologia/economia , Hospitais de Ensino , Obstetrícia/economia , Médicos , Equipamentos Cirúrgicos/economia , Adulto , Conscientização , Análise Custo-Benefício , Educação de Pós-Graduação em Medicina , Feminino , Ginecologia/educação , Humanos , Masculino , Obstetrícia/educação , Inquéritos e Questionários
14.
Am J Obstet Gynecol ; 221(2): 156.e1-156.e6, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31047880

RESUMO

BACKGROUND: Only 64% of obstetrics and gynecology program directors report routine, scheduled training in abortion, despite the Accreditation Council for Graduate Medical Education's requirements for routine training. Most report that exposure to training is limited to specific clinical circumstances. OBJECTIVE: We sought to describe residency program directors' perspectives of support for and resistance to abortion training in residency training programs in the United States. MATERIALS AND METHODS: A national survey of directors explored the availability of abortion training as well as support for and resistance to abortion training within their departments and institutions. In addition, directors who indicated that training was not available at all, available only as an elective, or as routine but limited to specific clinical circumstances, were also asked which procedures were limited, in what ways, and by whom. Descriptive and bivariate analyses were performed. RESULTS: A total of 190 residency program directors (79%) responded from throughout the United States (30% in the Northeast, 30% in the South, 23% in the Midwest, and 16% in the West), and 14% described their program as religiously affiliated. Most directors (73%) reported at least some institutional or government restrictions to training, and reported an average of 3 types of restrictions. Hospital policy was the most commonly reported restriction, followed by state law. Programs with routine abortion training reported an average of 2 restrictions, compared with 4 restrictions in programs with optional training, and 5 restrictions in programs with no abortion training. CONCLUSION: Significant barriers to integrating abortion training into residents' schedules continue to exist decades after the Accreditation Council for Graduate Medical Education training mandate. We should use these data to develop better support and targeted strategies for increasing the number of trained abortion providers in the United States.


Assuntos
Aborto Induzido/educação , Aborto Induzido/legislação & jurisprudência , Ginecologia/educação , Internato e Residência , Obstetrícia/educação , Currículo , Administração Hospitalar , Humanos , Política Organizacional , Governo Estadual , Inquéritos e Questionários , Estados Unidos
15.
Int J Gynaecol Obstet ; 146(1): 132-138, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31044431

RESUMO

Failure to acknowledge the impact of sex and gender differences affects the quality of health care provision, and is an impediment to reducing health inequities. Systematic efforts were initiated in Maharashtra, India for reducing these disparities by developing gender-integrated curricula in undergraduate (UG) medical education between 2015 and 2018. A review of UG obstetrics and gynecology curricula indicated a lack of gender lens and focus on the reproductive rights of women. Based on these gaps, a gender-integrated curriculum was developed, implemented, and tested with medical students. Significant positive attitudes were seen among male and female students for themes such as access to safe abortion; understanding reproductive health concerns and their complex relationship with gender roles; violence against women as a health issue; and sexuality and health. These results strengthened the resolve to advocate for such a curriculum to be integrated across all medical colleges in the state.


Assuntos
Educação de Graduação em Medicina/normas , Ginecologia/educação , Obstetrícia/educação , Currículo , Feminino , Humanos , Índia , Masculino , Gravidez , Saúde Reprodutiva/educação , Direitos Sexuais e Reprodutivos/educação , Estudantes de Medicina/estatística & dados numéricos , Saúde da Mulher
16.
Eur J Obstet Gynecol Reprod Biol ; 237: 157-163, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31051419

RESUMO

OBJECTIVES: Knowing and understanding the reasons why medical students choose postgraduate medical specialities are essential to help influence the workforce for a balanced national healthcare system. The objective of this study was to determine motivating factors for choosing a speciality career in general and, more specifically, for the choice of obstetrics and gynaecology (OBGYN) over surgery or general practice. STUDY DESIGN: This study was based on prospectively collected data from a large research multi-site cross-sectional study. We sent a survey to medical students in the sixth year, which contained questions about demographics, choice of speciality and motives for choosing. We grouped the specialities into families of specialities and motives into motivating factors clustered by principal component analysis. We used a multivariate analysis of variance (MANOVA) test to identify differences between motivating factors in speciality categories and gender. We performed logistic regression analyse to compare the choice of OBGYN to choices of surgery and general practice as well as undecided. RESULTS: A total of 1749 students responded with an average return rate of 56%. Our study revealed four motivating factors: "experiential", "relational", "occupational" and "scientific". Logistic regression analysis showed that the choice of OBGYN was particularly influenced by "experiential factor" (OR 1.5; 95%CI [1.2; 1.9]) and by gender (OR 4.5; 95%CI [2.2; 9.2]). When we compared the motivational profile of OBGYN to other speciality categories, OBGYN appeared to stand between surgery and general practice for the "experiential" and "relational" factors, more like surgery for the "occupational factor" and more like general practice for the "scientific factor". CONCLUSION: This study highlighted the importance of "experiential factor" and gender for choosing OBGYN as a career. OBGYN seemed to stand between surgery and general practice from a Swiss students' point of view. These findings provide useful information for targeted interventions to promote OBGYN at the undergraduate level. Such interventions could include providing more hands-on experiences, improving integration of male students and encouraging student involvement in patient care.


Assuntos
Escolha da Profissão , Educação de Graduação em Medicina , Ginecologia/educação , Motivação , Obstetrícia/educação , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Prospectivos , Estudantes de Medicina , Inquéritos e Questionários
17.
Obstet Gynecol Clin North Am ; 46(2): 305-315, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056132

RESUMO

Ensuring patient safety and optimizing outcomes in obstetrics and gynecology through improving technical skills, enhancing team performance, and decreasing medical errors has resulted in significant interest in incorporating drills and simulation into medical training, continuing education, and multidisciplinary team practice. Drills and simulations are ideal because of their wide range of application with various learners and settings. They provide a safe space to learn and maintain technical skills and to improve knowledge, confidence, communication, and teamwork behaviors, particularly for less common, high-stakes clinical scenarios.


Assuntos
Competência Clínica/normas , Educação Médica Continuada/métodos , Ginecologia/educação , Obstetrícia/educação , Segurança do Paciente , Treinamento por Simulação , Animais , Feminino , Humanos , Erros Médicos/prevenção & controle , Gravidez
19.
J Pediatr Adolesc Gynecol ; 32(4): 354-358, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31091469

RESUMO

Vaginal dilator therapy is used to increase vaginal length for vaginal agenesis, to increase vaginal width for vaginal narrowing, and to prevent or treat stenosis after vaginal surgery. Although it is an effective therapy, many reproductive health providers have had little training on how to guide patients through this therapy. The purpose of this review is to educate providers on how to assess patient readiness and how to support patients through the process of vaginal dilation.


Assuntos
Anormalidades Congênitas/terapia , Dilatação/instrumentação , Vagina/anormalidades , Feminino , Ginecologia/educação , Humanos , Resultado do Tratamento
20.
Gynecol Obstet Fertil Senol ; 47(6): 510-515, 2019 06.
Artigo em Francês | MEDLINE | ID: mdl-30959187

RESUMO

OBJECTIVE: Compare the professional aspiration and obstacles in gynecology and obstetrics residents careers between Lille and Paris. METHODS: We conducted a cross-sectional survey, using questionnaires sent by e-mail to residents in obstetrics and gynecology in Lille. An analysis by genre was made, and those results were compared to results obtained in a same study with Parisian residents. RESULTS: Among the 73 residents in training in Lille, 63 responded (86.3%), of them 53 those were women and 10 were men. No woman answered wanting to start an academic career, however 50% of men did (P=0.001). The global analysis found obstacles to an academic career in defined areas such as: lack of mentors, lack of identification in a same sex role model or women doubting more than men in their abilities to achieve this career. The comparison between the two cities shown a greater gap between women and men in Lille: women in Lille were most reluctant to engage in academic careers and have not the prerequisites (diplomas, mobility or publications) that seem necessary for this type of career. CONCLUSIONS: Women were less expecting to have academic careers in Lille than in Paris. Many barriers have been identified as difficulties for them to follow this career path. It is important to develop strategies to encourage women in gynecology and obstetrics to find their place in research and teaching, since they are most present in this specialty.


Assuntos
Escolha da Profissão , Ginecologia/educação , Internato e Residência/estatística & dados numéricos , Obstetrícia/educação , Adulto , Estudos Transversais , Docentes de Medicina , Feminino , França , Humanos , Masculino , Mentores , Paris , Pesquisadores , Fatores Sexuais , Inquéritos e Questionários
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